Facing Death, Embracing the Life Cycle

In Twelve Breaths a Minute, an exceptional anthology examining death, editor Lee Gutkind admits that he originally shared the sentiment of a colleague who suggested the “combined effect of the book was … completely depressing.” But upon further contemplation, Gutkind, founding editor of Creative Nonfiction magazine, came to view the book’s message as positive. While it’s important not to confuse “positive” with “upbeat” in this instance, I wholeheartedly agree with his later assessment. The 23 essays—individually and collectively—are (pardon the ill-advised pun here) utterly breathtaking.

I devoured the book in big chunks, immersing myself deeply and willingly in end-of-life musings offered through myriad prisms. Many of the selections deal with the dying elderly but more than a couple address the agony of losing a child. My eagerness to take in sometimes-graphic descriptions—of bone-breaking medical procedures, nursing home nightmares and the blood-shit-piss elements attendant to so many deaths—was not the sort of voyeuristic fascination one associates with watching an accident scene. Instead I was awed by the generosity of the writers, each of whom reached deep into wells of visceral grief, not bothering to try to prettify this thing that, unlike taxes, none of us can evade.

The essayists strip away conventional Western platitudes that try futilely to dodge grief’s bullet—“She’s in a better place now”— and get straight to the expiring heart of the matter. Despite this rawness, this refusal to mince words, there is no shortage of poetry here. And though contributors include a doctor, lawyer, nurse and chaplain, all write with an eloquence and thoughtfulness that suggest they have spent ample time honing literary skills.

In Twelve Breaths a Minute we encounter people who are dying and fighting this fate, demanding “heroic measures, “ exhibiting a reluctance to let go. We also meet those who sign “do not resuscitate” orders, those who opt for hospice over dying in a hospital room hooked to hoses and ventilators, or choose palliative care rather than another brutal round of chemotherapy. Some start out desperate to live at any cost before choosing to let go and end the pain. Beecher Grogan begins her essay, “Simple Gifts” without embellishment: “For my twelve-year-old daughter, death was a welcome friend.” From this raw starting point, Grogan details four harrowing years of treatment, remission, and more treatment until her daughter, Lucy, begs her doctor to kill her.

The book addresses death from numerous angles—from statistics about hospital deaths to information about the funeral business, and from the clenching grip of grief to suicide to how we measure our limited moments on this earth. Several of the essays portray doctors grappling with feelings of helplessness and indecision when faced with the knowledge that to keep a patient breathing also means to keep that patient suffering.

And then there are the essays in which doctors find themselves moved personally. In” Wake-up Call,” Austinite and surgeon Catherine A. Musemeche recounts her mother’s last days, five years after being diagnosed with an aneurysm that eventually ruptured. Despite her professional experience assisting in the repair of aneurysms, when Musemeche finds herself in the role of daughter holding ICU vigil, a conflict arises: “She is very much alive at this moment, and she still has a chance. But I am not just her daughter. I am also a surgeon, armed with too much medical knowledge. It gets in the way of my ability to hope.”

In the end, she concludes: “Like everyone else in this situation, I have had to learn the difficult truth. We don’t get to script these endings … death chooses its own time and circumstances.”

That is the overarching theme in this diverse collection. But there are other lessons to be learned. I came away from Twelve Breaths a Minute with several newly- formed resolutions. I vowed to think long and hard—and soon (as in now)—about how and where I want to die, if I am lucky enough to be aware enough to choose between hospital and home. (Home, please.) I vowed, upon reading tale after tale of elderly people lapsing into deep depressions after vibrant lives—courtesy of pain, dementia and awful nursing home conditions—to be more mindful of senior citizens And I contemplated the benefits of squirreling away enough pain meds should my own physical health deteriorate to the point that death would be a welcome friend.

In America, many of us avoid the topic of death, as if our collective ignorance might stave off this thing that is as much a part of the life cycle as birth. Fear informs our avoidance. An increasing number of magical medical methods can prolong our lives, if not the quality of that extra time. As millions of baby boomers reach the final decades of their lives, the numbers of the dying—and those hoping to postpone death through medical intervention—are swelling. Even if this were not the case, I would suggest mandatory reading of Twelve Breaths a Minute by every person old enough to comprehend its contents.

Many of the harsh truths here might be hard to swallow. But the overall effect, as Gutkind came to understand in assembling the collection, is very positive indeed, inviting us to tear off our death blinders and consider what the future holds for every one of us.

Spike Gillespie lives, breathes, and most likely will die in Austin. She is the author of six books, and blogs as whim dictates at www.spikeg.com and www.writewithspike.com